Medically reviewed by Shahrzad Shadmani, PMHNP-BC, FNP-C, founder of Integrative Psychiatry and Wellness (IPW Health).
Published September 16, 2026.
You go in for your yearly visit, get your blood pressure taken, hand over a clipboard, and somewhere on it are a few questions about mood. You answer them quickly. Maybe you round down. The visit moves on to cholesterol.
Those few questions are doing more work than they look like they are doing — and when they are used properly, they are one of the more reliable ways psychiatric conditions get caught before they become severe. Here is what is actually happening in that part of the visit, and what should happen next.
First, a terminology problem worth clearing up
“Annual Wellness Visit” is the name of a specific benefit under Medicare Part B, and it is not the same thing as a yearly physical. The Medicare visit is a prevention-planning appointment: a health risk assessment, a medical and family history, a review of current providers and medications, routine measurements, detection of cognitive impairment, a review of risk factors for depression, a functional and safety assessment, and a written personalized prevention plan. Notably, it does not include a head-to-toe physical examination, and people are often surprised by that.
Most people using the phrase mean something looser — a yearly check-in with a clinician who knows them. Both are worth having. But if you are on Medicare and want the covered benefit, ask for it by name; the coverage rules differ from those for a problem-focused visit or a physical.
Why mental health belongs in a preventive visit
The case is straightforward. Depression and anxiety disorders are common, they are treatable, and they are frequently missed — often because the presenting complaint is fatigue, insomnia, pain or poor concentration rather than sadness or worry. A preventive visit is one of the few points of contact where someone asks the question directly instead of waiting for the patient to raise it.
The US Preventive Services Task Force recommends screening adults for depression, and recommends screening for anxiety disorders in adults within a defined age range. Both recommendations come with a condition attached: screening should be implemented where there are systems in place to ensure accurate diagnosis, treatment and follow-up. A screen with nothing behind it is not preventive care.
The instruments, by name
Two short questionnaires do most of this work in primary care, and you have probably filled out at least one.
The PHQ-9 is a nine-item depression questionnaire. Its items map onto the diagnostic criteria for major depressive disorder, and you rate how often each has bothered you over the past two weeks. It produces a total score used to gauge symptom severity, and it is also used to track change over time — the same nine questions repeated at intervals show whether treatment is working. A shorter two-item version, the PHQ-2, is often used first, with the full nine administered only if the short version is positive.
One item on the PHQ-9 asks about thoughts of being better off dead or of hurting yourself. If you endorse it, expect to be asked about it directly. That is not an overreaction; it is the instrument working.
The GAD-7 is a seven-item anxiety questionnaire covering the past two weeks. It was developed to screen for generalized anxiety disorder and performs reasonably as a general indicator of anxiety symptoms, including in panic and social anxiety. A two-item short form, the GAD-2, is used the same way as the PHQ-2.
Both are brief, validated, free to use, and well studied in primary care. Neither is a diagnostic test.
What a positive screen does and does not mean
This is the part that gets lost.
A score is not a diagnosis. These instruments are built to be sensitive — to catch as many people with the condition as possible — and the cost of that sensitivity is false positives. Many people who screen positive will not meet criteria on a full assessment.
A positive screen means the next conversation should happen. Diagnosis requires a clinical interview: how long symptoms have lasted, how much function they are costing, what else could account for them, whether there is a history of mania or hypomania, what substances and medications are involved, and whether there is risk.
A negative screen does not close the question. If you played down the answers, or if what you have does not look like the items on the form, the number will be reassuring and wrong. Say what is actually going on.
The number is most useful over time. A single score is a snapshot. The same score repeated over months is a measurement, and it is one of the better tools available for judging whether a treatment is working.
The medical workup that overlaps with psychiatric symptoms
Several ordinary medical conditions produce symptoms that look like depression or anxiety, which is why a preventive visit that includes mental health should also include the relevant physical evaluation.
- Thyroid function. Both underactive and overactive thyroid can present as depression, anxiety, fatigue or cognitive slowing.
- Anemia and iron status. Fatigue, poor concentration and low tolerance for exertion overlap heavily with depressive symptoms.
- Vitamin B12 deficiency. Can produce mood change and cognitive complaints, and is more likely with certain diets, with some medications, and with age.
- Metabolic measures, including glucose and lipids. Relevant both as contributors to how you feel and as monitoring if you take psychiatric medication that affects them.
- Medication and substance review. Some non-psychiatric medications contribute to low mood or fatigue, and alcohol, cannabis, nicotine and caffeine all affect sleep and anxiety.
- Sleep. Including screening for obstructive sleep apnea, which produces fatigue, low mood and cognitive complaints and is frequently mistaken for depression.
Which tests are appropriate depends on your history and symptoms. This is not an argument for testing everything measurable — broad panels ordered without a question in mind produce incidental findings and anxiety rather than answers.
IPW orders and interprets laboratory work directly, so when the psychiatric and the medical questions overlap, both can be pursued in the same place.
When a screen should lead to a psychiatric referral
Primary care manages a great deal of depression and anxiety well. Referral is worth making when:
- Symptoms are severe, or function is significantly impaired.
- There are thoughts of self-harm or suicide.
- There is a history of mania or hypomania, or a family history of bipolar disorder — antidepressant treatment decisions change materially in that case.
- There are psychotic symptoms.
- A first-line treatment has been tried adequately without adequate response.
- There is significant substance use alongside the mood or anxiety symptoms.
- The person is pregnant, planning pregnancy or postpartum.
- The picture is complicated — several diagnoses at once, or symptoms that do not fit a single condition.
What to do with this
If you have a yearly visit scheduled, answer the mood questions honestly rather than efficiently. If you have already screened positive and nothing followed, that is worth raising — the screen is only useful if something happens after it.
IPW Health provides psychiatric evaluation and medication management by telehealth in California, Oregon, Washington and Colorado, and in person in Mission Viejo, California. Our clinicians order and interpret laboratory work directly, which means the medical contributors described above can be evaluated alongside the psychiatric assessment. Call (949) 259-5123.
This article is general education, not medical advice, and reading it does not create a patient–provider relationship. Treatment decisions depend on your history and should be made with a clinician who knows it.
If you are in crisis or having thoughts of harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day in the United States. If you are in immediate danger, call 911.
Sources
- US Preventive Services Task Force. Depression and Suicide Risk in Adults: Screening; Anxiety Disorders in Adults: Screening.
- Centers for Medicare & Medicaid Services. Medicare Wellness Visits (MLN educational product).
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
- National Institute of Mental Health. Depression; Anxiety Disorders.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Hypothyroidism (Underactive Thyroid); Hyperthyroidism (Overactive Thyroid).
- National Heart, Lung, and Blood Institute (NIH). Iron-Deficiency Anemia; Sleep Apnea.
- Centers for Disease Control and Prevention. About Mental Health.
